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Hawaii DOH

About the Author

Victoria Fan

Victoria Fan is an associate professor at the University of Hawaii Manoa and an adjunct fellow at the East-West Center. She is the founder of the Hawaii Pandemic Applied Modeling Workgroup and the director of the UH Pacific Health Analytics Collaborative. She can be reached at vfan@hawaii.edu.


To answer the question posed by this column鈥檚 headline, I do not mean that Hawaii has too many cardboard or plastic boxes. I mean the boxes drawn on an organization chart.

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This unsexy management tool called the organization chart is one of the most important ways that defines how a public agency is structured and, for lack of a better word, organized.

The other two well-known tools are hiring and procurement. Procurement even has its own dedicated two full chapters 鈥 Hawaii Revised Statutes Chapter and . This is the bible for public administrators and managers to purchasing and getting stuff done. Yet to my knowledge, there is no single law governing the structure of boxes in the organization chart of public agencies.

What if we鈥檙e asking the wrong question?

Often the question from the public or from policymakers is: Do we have too much, or too little, government?

But what if this was the wrong question? What if the real question is not whether we have too little government (such as not enough epidemiologists) or too much government (such as too many civil servants)?

What if the question we should be asking is: Is the way in which government is organized smart? How do organization boxes affect government operations?

A Tale Of Two Agencies

Let us compare side by side 鈥 the Department of Human Services and the Department of Health.

The first has a budget and staff of $3.8 billion and 2,292 permanent positions (of which 1,131 are general funded), while the second has a budget and staff of $1 billion and 2,769 permanent positions, according to the Department of Budget and Finance.

But when it comes to the organization chart, the latter DOH has 80-plus boxes on its top-level organization chart, whereas the former DHS has 13 such boxes. On average, there are 35 people per box in the Department of Health compared to 176 people per box in the Department of Human Services, although actual people per box varies greatly.

Who cares about boxes?

DOH org chart
The DOH organizational chart. Hawaii DOH

I have seen firsthand the detriment of too many boxes and too few people per box.

The lead supervisor of a box, i.e., an administrator, may be paid according to the number of people in their box. It also means the administrator does not want to let their staff go to help another box or unit in need of help.

Staff and budget are the territory of administrator politics. Reassigning tasks from one person in one box to another person in another box is quite challenging.

We saw the risk of the “one box approach” repeatedly during Covid when a single box, the Disease Outbreak Control Division, was tasked with Covid response. Yet it lacked the authority to bring together staff in other boxes to support core activities of testing, tracing, and isolation and quarantine.

Fortunately, in 2020, the DOH director Bruce Anderson understood this problem, and he went out of the box to get help from an entirely different administration in DOH, let alone box, the Behavioral Health Administration, to support isolation and quarantine activities. I can speak firsthand because BHA then asked UH to help coordinate isolation and quarantine activities for Honolulu, and we did it. This was a rare case where coordination occurred despite boxes.

But the truth is that boxes create silos and fragmentation. The DOH has perhaps聽a dozen epidemiologists or “epi” for short, but they are scattered across the department in different units, making it challenging to pool all the 鈥渆pis鈥 altogether. When a division’s epi retires or leaves, they are left in the lurch without an epi.

Revisit And Reimagine Structure

The word “reorganization” usually sends shudders down people’s backs, and status quo is more relaxing. Merging boxes is an exercise in upsetting administrators’ fiefdoms. Government is terrible at merging old boxes together (and notoriously good at creating new boxes).

But if the state aspires to be modern, state agencies should revisit their organization chart from time to time and ask how the structure helps or hinders what needs to get done. Collective bargaining is just an excuse, but it can be aligned to build high-performing institutions.

To its credit, the DOH does do pooling in one area 鈥 for information technology. Its IT staff are pooled centrally, but assigned on a dotted line basis to various division boxes. When one IT staff leaves their dotted line division, central IT services has the potential to reassign or temporarily get support from another IT staff member to help.

But for epidemiologic services, forget it. Every box (and administrator) is for itself, despite Hawaii Revised Statutes which mandates a centralized statistics bureau. This central mandate is not implemented at all; in practice, data and statistics in DOH are entirely decentralized. (Unimplemented mandates are a dime a dozen, but that’s a story for another day.)

I have seen firsthand the detriment of too many boxes and too few people per box.

Territoriality and politics complicate resource sharing further, particularly when administrators seek legislative support to add more staff lines for its box (and also help the administrator get a pay increase, ’cause remember, more supervisees, higher pay!).

We need out-of-the-box thinking, literally, to make the public sector work better. To make government share internally resources better, we need to reduce the number of boxes and create incentives for administrators to share staff and resources. Reimagining organization is unglamorous and rife with political hazards, but in the long run it has the potential to build a better performing government.

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About the Author

Victoria Fan

Victoria Fan is an associate professor at the University of Hawaii Manoa and an adjunct fellow at the East-West Center. She is the founder of the Hawaii Pandemic Applied Modeling Workgroup and the director of the UH Pacific Health Analytics Collaborative. She can be reached at vfan@hawaii.edu.


Latest Comments (0)

An excerpt from the Department of Budget and Finance's webpage highlights the enormous power of the Governor:"The executive and administrative offices are limited to not more than twenty principal departments under the supervision of the Governor. The executive functions have in fact been grouped into eighteen departments. The heads of the departments are appointed by the Governor, with the advice and consent of the Senate, and hold office for a term to expire with the term of the Governor."Anyone who has ever been a state employee knows that if the Governor really wants something to happen, it happens (subject to available funding).The Governor and a majority of legislators (funding) are tied to commercial interests through campaign financing -- our government actually works pretty well for those interests (otherwise they wouldn't bother paying for it).Until we get commercial interests out of elections, it won't matter how we arrange the boxes.

oppo · 2 years ago

I don't think the Dept of Human Services is a good model either. Their purpose is vage, and they are responsible for the failure to use logic and do what every other state in this country figured out a year before Hawaii did, viz, go back to normal in schools.

DuDaMath · 2 years ago

Every dollar of these budgets: $3.8 billion and $1 billion, come out of the pockets working people and businesses. These are added to the other public expenditures which must also he paid for. A great many people in the government sector are throughly convinced of the necessity of these expenditures, but the cost of these are passed onto the people. We then wonder why people are getting priced out of paradise (evil speculators?) and can芒聙聶t figure out how to solve the homeless crisis. But at least we have some government funded (taxpayers) programs to address the thorny homelessness issue. I don芒聙聶t suppose many of the homeless or unemployed are part of the government class.

Arewethereyet · 2 years ago

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